Spinal reflexes and the concentrations of 5-HIAA, MHPG, and HVA in lumbar cereborspinal fluid after spinal lesions in man

The H-Reflex as a Biomarker for Spinal Disinhibition in Painful Diabetic Neuropathy

PURPOSE OF REVIEW

Neuropathic pain may arise from multiple mechanisms and locations. Efficacy of current treatments for painful diabetic neuropathy is limited to an unpredictable subset of patients, possibly reflecting diversity of pain generator mechanisms, and there is a lack of targeted treatments for individual patients. This review summarizes preclinical evidence supporting a role for spinal disinhibition in painful diabetic neuropathy, the physiology and pharmacology of rate-dependent depression (RDD) of the spinal H-reflex and the translational potential of using RDD as a biomarker of spinally mediated pain.

RECENT FINDINGS

Impaired RDD occurs in animal models of diabetes and was also detected in diabetic patients with painful vs painless neuropathy. RDD status can be determined using standard neurophysiological equipment. Loss of RDD may provide a clinical biomarker of spinal disinhibition, thereby enabling a personalized medicine approach to selection of current treatment options and enrichment of future clinical trial populations.

Cerebrospinal fluid cell count following spinal cord injury

Cerebrospinal fluid (CSF) changes after spinal cord injury (SCI) were evaulated by retrospective analysis of all patients admitted to the Acute Spinal Cord Injury Unit (ASCIU) at University Hospital, Shaughnessy Site in Vancouver, British Columbia. A total of 1,917 admissions occurred during the 10-year study period with 1,151 due to acute trauma. The charts of all patients with SCI due to trauma were reviewed to identify patients in whom a CSF puncture was performed for any reason. Traumatic SCI is associated with elevations in the corrected white blood cell count (cWBC) that we believe reflect an inflammatory response to injury. The elevation in cWBC is greatest in the first week after injury. Elevations in cWBC more than 1 week after injury do occur but are uncommon. The white cell differential count consists primarily of lymphocytes and polymorphonucleocytes. Three weeks after injury cell counts should be normal. Protein levels are elevated after trauma and should not be used to assess the presence of infection. LP should be part of the septic workup of SCI patients just as it would be for any other population if meningitis is a consideration.

A comparative study of methods for estimation of presynaptic inhibition

The influence of vibration on the H-reflex and on the tendon reflex amplitudes was compared and the efficacy of both methods for the assessment of the presynaptic inhibition was studied. One hundred and twenty patients with post-stroke spastic hemiparesis were investigated. Muscle tone, muscle force and tendon reflexes were assessed. The H-reflex and the Achilles tendon reflex (TA) were recorded under identical experimental conditions. Vibration at a frequency of 100 Hz and an amplitude of 2 mm was applied to the TA. Just after vibration the maximal amplitudes of both reflexes were measured. The ratios of reflex amplitudes after vibration to normal maximal reflex amplitudes (Hvibr/Hmax and TAvibr/TAmax) were evaluated. In all patients with hemiparesis the healthy side was used as a control. Our results revealed significantly increased amplitude ratios on the spastic side. Hence it is concluded that presynaptic inhibition is decreased in spasticity. The amplitude ratios on the healthy and the spastic side were consistent. There was good positive correlation between Hvibr/Hmax and TAvibr/TAmax ratios, suggesting that they provide similar and reliable estimates of presynaptic inhibition.

Correlations between aminergic metabolites simultaneously obtained from human CSF and brain

Brain and cerebrospinal fluid (CSF) levels of homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) were simultaneously measured in 48 individuals at autopsy. Concentrations of 5-HIAA and HVA in the cerebral cortex were positively correlated with their levels in the CSF for the same individual. Additionally a positive correlation was observed between postmortem CSF levels of 5-HIAA and HVA and a significant concentration gradient for both metabolites was observed in serial fractions of CSF. These findings suggest that determinations of 5-HIAA and HVA in CSF from living individuals may reflect brain metabolite levels as well as the functional activity of these specific neuronal systems.

Rat brain and plasma norepinephrine glycol metabolites determined by gas chromatography-mass fragmentography

A gas chromatographic-mass fragmentographic (GC-MF) procedure is described for the simultaneous quantitation of 3,4-dihydroxyphenylethyleneglycol (DHPG) and 3-methoxy-4-hydroxyphenylethyleneglycol (MHPG) in brain tissue and plasma. DHPG and MHPG were assayed as their respective acetyl-trifluoroacyl esters, using [2H2]DHPG and [2H3]MHPG as internal standards. Assay sensitives of at least 1 ng per sample were attainable for the quantitation of free glycols, whereas for determination of total DHPG, assay sensitivity was 2.5 ng. Whole rat brain total (99.2 +/- 4.11 ng/g) and free (13.0 +/- 1.14 ng/g) DHPG concentrations were similar to respective total (86.0 +/- 3.70 ng/g) and free (12.3 +/- 0.41 ng/g) MHPG levels. Total DHPG concentrations exceeded total MHPG levels in hypothalamus (3.0:1), midbrain (1.4:1), pons plus medulla (1.3:1), and hippocampus (1.5:1), whereas in other brain regions the levels of these metabolites were similar. In plasma, however, total DHPG levels were only 20% as high as MHPG concentrations. In mouse brain, DHPG and MHPG occurred almost entirely in free form (greater than 90%), but total DHPG levels were only 50% as high as respective MHPG concentrations. These results emphasize the substantial formation of DHPG compared with MHPG in rat and mouse brain and suggest that DHPG formation and efflux may be of equal or greater importance than MHPG in the metabolic clearance of CNS norepinephrine in some species.